Management of breast cancer is taking a less invasive approach. Despite progressive de-escalation of management of axillary disease, axillary lymph node dissection (ALND) still has a role in regional disease control. Seminal studies against routine ALND following a positive sentinel lymph node biopsy (SLNB) have been shown to apply to 9.3% of breast cancer cases in Australia. Additionally, 27.3% of patients who had positive axillary lymph node (LN) had non-positive SLNB. This demonstrates that there is still a population of women who would benefit from ALND. Our aim is to identify predictors of positive LN to guide surgeons making decision for axillary treatment for patient. All women underwent Level 1-3 ALND for breast cancer at the Royal Brisbane & Women’s Hospital (RBWH) between 2008 to 2022 were analyzed. Data was retrieved from a prospectively maintained Breast Surgical Unit database at RBWH. This provided variables to look for possible factors in predicting Level-3 LN positivity. STATA18 software was used for analysis. 56 variables were selected for analysis with logistic regression or chi-square test. A total of 402 patients had been included in the cohort. 22.1% of patients had positive Level-3 LN. 176 patients received SLNB and subsequent ALND, 10.5% of patients in this group had Level-3 LN metastasis. We identified that pathological factors including presence of high-grade tumour, lymphovascular invasion, pT3 tumour, HER-2 positive, and ER/PR negative status were predictors for Level-3 LN metastasis. The analysis revealed several significant pathological predictors for Level-3 LN metastasis. Insight into these factors could aid surgeons in their treatment planning regarding whether a patient would benefit from ALND.